A recent analysis of the Global Burden of Disease (GBD) 2019 data, has revealed the startling data that approximately 1.71 billion people worldwide suffer from musculoskeletal conditions.
These conditions, ranging from low back pain and fractures to osteoarthritis and rheumatoid arthritis, affect people of all ages and are a cause for concern globally.
According to the World Health Organisation (WHO), musculoskeletal conditions are typically characterised by pain (often persistent), limitations in mobility and dexterity, and reducing people’s ability to work and participate in society.
Pain experienced in musculoskeletal structures is the most common form of non-cancer pain.
Musculoskeletal conditions encompass a wide array of disorders affecting various parts of the body, including joints, bones, muscles, and multiple body systems.
Joints, such as those affected by osteoarthritis, rheumatoid arthritis, gout, and spondyloarthritis, experience inflammation and degradation, resulting in debilitating pain and stiffness.
Bones, including those impacted by osteoporosis and associated fragility fractures, can have severe consequences for individuals.
Conditions like sarcopenia affect muscle mass and strength, leading to weakness. Additionally, pain conditions such as back and neck pain, as well as widespread pain conditions like fibromyalgia, further add to the spectrum of musculoskeletal disorders.
Chronic inflammatory diseases like connective tissue diseases and vasculitis also contribute to a range of debilitating symptoms.
Tony Singleton, CEO of Turnberry Insurance, speaking against the context of Bone and Joint Health National Action Week, sheds light on the financial implications tied to musculoskeletal conditions.
He said these conditions not only result in some of the most expensive claims witnessed by insurance providers but are also among the most frequently claimed for.
The vast umbrella of musculoskeletal conditions contributes to a wide array of claims, ranging from hip-bone fractures and replacements, to lower back pain and shoulder inflammation, such as rotator cuff tendonitis.
Ligament tears, sprains, herniated discs, and even congenital conditions like scoliosis further add to the financial burden on individuals and healthcare systems.
He added: “The reality is that muscular-skeletal conditions, or those affecting the bones, muscles, tendons, ligaments and soft tissues, can happen to people of any age.
“While some are degenerative and affect people more as they advance in age, accidents do not discriminate, and they can come with hefty medical expenses.”
In addition, procedures related to the muscular-skeletal system are frequently not fully covered by medical schemes, leaving people with significant medical expense shortfalls that need to be paid out of pocket.
Gap cover gives everyone, young and old, peace of mind that they are protected from this financial burden, said Singleton.
“Musculoskeletal treatments often require a significant upfront co-payment. For example, we have covered claims with a co-payment of R32,500 for gonarthrosis (knee osteoarthritis) or knee cartilage degeneration, and a co-payment of R38,000 for surgery related to idiopathic scoliosis.
“Many people are also not aware that most medical schemes impose co-payments on joint replacement surgery, with some being as high as 25% of the hospital account,” he said.
Accidents can result in medical expense shortfalls from various sources. These include fees from the casualty department, shortfalls from doctors, surgeons, specialists, and anaesthesiologists who charge above the medical aid tariff, sub-limits on internal prostheses, and the cost of using a non-designated service provider hospital.
Without gap cover, musculoskeletal conditions can lead to significant out-of-pocket expenses, creating a heavy financial burden.
Turnberry customer Len Leuw, who has been with the company for 15 years, recently underwent a hip replacement. He had to make an upfront co-payment of R4,930 even before being admitted.
“To his surprise, both the orthopaedic surgeon and the anaesthesiologist charged three times the medical aid rate for the surgery. This resulted in shortfalls of R27,932 for the surgeon and R8,374 for the anesthesiologist.
“In total, the surgery left Leuw with shortfalls amounting to R41,236, which he would have had to cover out of his pocket,” shared Singleton.
“The long and short of it is that muscular-skeletal conditions can affect anyone, regardless of overall health or age, and the medical shortfalls can be significant. Specialists typically charge three to five times the medical aid rate, and this can run to many thousands of Rands.
“Gap cover is invaluable in helping to ease the financial strain these would otherwise cause.
“Understanding your medical aid cover and having the right gap policy to augment it is essential and one should seek assistance from their financial advisor to obtain the correct gap cover offering to meet your needs,” said Singleton.
